In this report, we update our earlier projections of Medicaid enrollment and costs in 2022 and 2023. We find the following:
- The Medicaid continuous coverage requirement has provided stable health coverage to millions of people during the pandemic and has helped prevent the number of uninsured people from increasing in the wake of pandemic job losses.
- The longer the PHE lasts, the greater the potential number of people losing Medicaid coverage over the 14 months after the PHE ends and normal eligibility processing resumes: 12.9 million if it expires after the first quarter of 2022, 14.4 million if it expires after the second quarter, and 15.8 million if it expires after the third quarter.
- People losing Medicaid coverage risk becoming uninsured. We estimate many of them would be eligible for other subsidized health insurance coverage through the Children’s Health Insurance Program (CHIP) or the Marketplace, but not all eligible people would enroll in these coverage sources because they may cost the affected families more than Medicaid. Further, if Congress does not extend the enhanced PTCs from the American Rescue Plan Act, many of these people will face higher premiums and decline to enroll, and others may lose eligibility for subsidized Marketplace coverage in 2023.
- The unprecedented volume of eligibility determinations that states will have to process raises concerns that eligible people could be unnecessarily disenrolled from Medicaid and become uninsured. Further, some stakeholders worry the rate at which enrollees are inappropriately disenrolled will be higher after the PHE than was typical before the pandemic. If this happens, the number of people losing coverage could be higher than we project.
- Compared with PHE expiration after the first quarter of 2022, federal government spending on Medicaid in 2022 and 2023 would be $34.0 billion higher if the PHE were extended for one additional quarter and $70.5 billion higher if the PHE were extended for two quarters. State government spending in 2022 and 2023 would be $5.0 billion higher if the PHE were extended for one additional quarter and $10.9 billion higher if the PHE were extended for two quarters.
The original report was published by the Urban Institute in September 2021. We published this follow-up report in March 2022. In December 2022, we published a third installment. Our findings have been cited by the New York Times, the Washington Post, the LA Times, CNN, NBC News, CBS News, the Associated Press, USA Today, POLITICO, Bloomberg Businessweek, NPR, HuffPost, Forbes, and Axios, among many other media outlets.